Antiphospholipid syndrome - Revision history

Danbot: Add References

2026-03-22T09:34:44Z

Add References

← Revisión anterior		Revisión del 09:34 22 mar 2026
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	==See Also==		==See Also==
			<references/>

			==References==
	<references/>		<references/>

	[[Category:Heme/Onc]] [[Category:Rheumatology]]		[[Category:Heme/Onc]] [[Category:Rheumatology]]

Gpowellhb: /* Management */

2020-02-13T01:18:53Z

Management

← Revisión anterior		Revisión del 01:18 13 feb 2020
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	**Add [[hydroxychloroquine]] if patient has SLE		**Add [[hydroxychloroquine]] if patient has SLE
	**Warfarin contraindicated in pregnancy!		**Warfarin contraindicated in pregnancy!
			**DOACs (such as rivaroxaban, apixaban, and dabigatran) have not been shown to be effective in APS
	*[[IVIG]], [[plasmapheresis]], and steroids have ''not'' been proven to be of benefit in APS		*[[IVIG]], [[plasmapheresis]], and steroids have ''not'' been proven to be of benefit in APS

ClaireLewis at 23:35, 30 September 2019

2019-09-30T23:35:37Z

← Revisión anterior		Revisión del 23:35 30 sep 2019
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	==Background==		==Background==
	*APS definition (need 1 from each category):		*APS definition (need 1 from each category):
	**Presence of at least 1 of the following: DVT, arterial thrombosis, or pregnancy morbidity (eg fetal loss, preterm)		**Presence of at least 1 of the following: [[DVT]], [[arterial thrombosis]], or pregnancy morbidity (eg fetal loss, preterm)
	**Presence of at least 1 of the following antiphospholipid antibodies (aPL): lupus anticoagulant (LA), anticardiolipin (aCL), β2-glycoprotein-1 (β2-GP-1)		**Presence of at least 1 of the following antiphospholipid antibodies (aPL): lupus anticoagulant (LA), anticardiolipin (aCL), β2-glycoprotein-1 (β2-GP-1)

	*APS can occur as a primary condition or in setting of underlying disease (eg SLE)		*APS can occur as a primary condition or in setting of underlying disease (eg [[SLE]])
	*Lifelong anticoagulation with warfarin, with the following target INRs<ref>Movva S et a. Antiphospholipid Syndrome. eMedicine. Mar 24, 2015. http://emedicine.medscape.com/article/333221-treatment.</ref>		*Lifelong anticoagulation with [[warfarin]], with the following target INRs<ref>Movva S et a. Antiphospholipid Syndrome. eMedicine. Mar 24, 2015. http://emedicine.medscape.com/article/333221-treatment.</ref>
	**2.0-3.0 for venous		**2.0-3.0 for venous
	**3.0 for arterial		**3.0 for arterial
	**3.0-4.0 recurrent thrombosis		**3.0-4.0 recurrent thrombosis
	**ASA plus warfarin for severe/refractory cases		**[[ASA]] plus [[warfarin]] for severe/refractory cases

	===Pathophysiology===		===Pathophysiology===
	*Currently accepted theory: Susceptible patients (eg SLE) develop aPL after infection. After development of aPL, “second hit” stress required to develop full-blown APS. aPL affects coagulation by interacting with protein C, annexin V, platelets, proteases, tissue factor, and impairing ~~finbrinolysis~~		*Currently accepted theory: Susceptible patients (eg SLE) develop aPL after infection. After development of aPL, “second hit” stress required to develop full-blown APS. aPL affects coagulation by interacting with protein C, annexin V, platelets, proteases, tissue factor, and impairing fibrinolysis
	**“Second hit” stressors: smoking, prolonged immobilization, pregnancy, exogenous estrogen, malignancy, nephrotic syndrome, hypertension, hyperlipidemia		**“Second hit” stressors: smoking, prolonged immobilization, pregnancy, exogenous estrogen, malignancy, nephrotic syndrome, hypertension, hyperlipidemia

	==Clinical Features==		==Clinical Features==
	*Thrombocytopenia, increased PT/INR and aPTT		*[[Thrombocytopenia]], [[coagulopathy\|increased PT/INR and aPTT]]
	*[[Microangiopathic Hemolytic Anemia (MAHA)]]		*[[Microangiopathic Hemolytic Anemia (MAHA)]]
	*[[DVT]]/PE		*[[DVT]]/PE
	*Fetal loss		*Fetal loss
	*Heart valve disease		*Heart [[valvular emergencies\|valve disease]]
	*aPL-nephropathy		*aPL-nephropathy
	*Stroke/TIA, other neuro symptoms		*[[Stroke]]/[[TIA]], other neuro symptoms
	*Livedo reticularis		*Livedo reticularis

	==Differential Diagnosis==		==Differential Diagnosis==
	{{Hemolytic anemia DDX}}		{{Hemolytic anemia DDX}}

	~~==Evaluation==~~
	*Presence of DVT, arterial thrombus, or pregnancy morbidity (eg fetal loss, preterm)
	*Presence of aPL

	==Management==		==Management==
	*Anticoagulation ([[unfractionated heparin]], [[LMWH]], or [[warfarin]])		*[[Anticoagulation]] ([[unfractionated heparin]], [[LMWH]], or [[warfarin]])
	**No benefit in treatment or prophylaxis using [[ASA]] or [[plavix]]		**No benefit in treatment or prophylaxis using [[ASA]] or [[plavix]]
	**Add [[hydroxychloroquine]] if patient has SLE		**Add [[hydroxychloroquine]] if patient has SLE
	**Warfarin contraindicated in pregnancy!		**Warfarin contraindicated in pregnancy!
			*[[IVIG]], [[plasmapheresis]], and steroids have ''not'' been proven to be of benefit in APS
	*[[IVIG]], [[plasmapheresis]], and steroids have not been proven to be of benefit in APS

	===Catastrophic APS Treatment===		===Catastrophic APS Treatment===
	*Treat stress that precipitated catastrophic APS (eg infection), anticoagulation, high dose steroids		*Treat stress that precipitated catastrophic APS (eg infection), anticoagulation, high dose [[steroids]]
	**If evidence of microangiopathy ([[thrombocytopenia]], [[MAHA]]), add [[IVIG]] and [[plasma exchange]] to above regimen		**If evidence of microangiopathy ([[thrombocytopenia]], [[MAHA]]), add [[IVIG]] and [[plasma exchange]] to above regimen

Ostermayer: Text replacement - "DVT" to "DVT"

2017-01-27T17:45:33Z

Text replacement - "*DVT" to "*DVT"

← Revisión anterior		Revisión del 17:45 27 ene 2017
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	*Thrombocytopenia, increased PT/INR and aPTT		*Thrombocytopenia, increased PT/INR and aPTT
	*[[Microangiopathic Hemolytic Anemia (MAHA)]]		*[[Microangiopathic Hemolytic Anemia (MAHA)]]
	*DVT/PE		*[[DVT]]/PE
	*Fetal loss		*Fetal loss
	*Heart valve disease		*Heart valve disease

ClaireLewis: /* Management */

2016-11-13T23:51:06Z

Management

← Revisión anterior		Revisión del 23:51 13 nov 2016
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	==Management==		==Management==
	*Anticoagulation (unfractionated heparin, LMWH, or warfarin)		*Anticoagulation ([[unfractionated heparin]], [[LMWH]], or [[warfarin]])
	**No benefit in treatment or prophylaxis using ASA or plavix		**No benefit in treatment or prophylaxis using [[ASA]] or [[plavix]]
	**Add hydroxychloroquine if patient has SLE		**Add [[hydroxychloroquine]] if patient has SLE
	**Warfarin contraindicated in pregnancy!		**Warfarin contraindicated in pregnancy!

	*IVIG, ~~plasmapharesis~~, and steroids have not been proven to be of benefit in APS		*[[IVIG]], [[plasmapheresis]], and steroids have not been proven to be of benefit in APS

	===Catastrophic APS Treatment===		===Catastrophic APS Treatment===
	*Treat stress that ~~preceipitated~~ catastrophic APS (eg infection), anticoagulation, high dose steroids		*Treat stress that precipitated catastrophic APS (eg infection), anticoagulation, high dose steroids
	**If evidence of microangiopathy (thrombocytopenia, MAHA), add IVIG and plasma exchange to above regimen		**If evidence of microangiopathy ([[thrombocytopenia]], [[MAHA]]), add [[IVIG]] and [[plasma exchange]] to above regimen

	==Disposition==		==Disposition==

Rossdonaldson1: Text replacement - "prophy " to "prophylaxis "

2016-09-08T15:27:44Z

Text replacement - "prophy " to "prophylaxis "

← Revisión anterior		Revisión del 15:27 8 sep 2016
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	==Management==		==Management==
	*Anticoagulation (unfractionated heparin, LMWH, or warfarin)		*Anticoagulation (unfractionated heparin, LMWH, or warfarin)
	**No benefit in treatment or ~~prophy~~ using ASA or plavix		**No benefit in treatment or prophylaxis using ASA or plavix
	**Add hydroxychloroquine if patient has SLE		**Add hydroxychloroquine if patient has SLE
	**Warfarin contraindicated in pregnancy!		**Warfarin contraindicated in pregnancy!

Rossdonaldson1: Text replacement - "HTN" to "hypertension"

2016-07-31T06:42:41Z

Text replacement - "HTN" to "hypertension"

← Revisión anterior		Revisión del 06:42 31 jul 2016
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	===Pathophysiology===		===Pathophysiology===
	*Currently accepted theory: Susceptible patients (eg SLE) develop aPL after infection. After development of aPL, “second hit” stress required to develop full-blown APS. aPL affects coagulation by interacting with protein C, annexin V, platelets, proteases, tissue factor, and impairing finbrinolysis		*Currently accepted theory: Susceptible patients (eg SLE) develop aPL after infection. After development of aPL, “second hit” stress required to develop full-blown APS. aPL affects coagulation by interacting with protein C, annexin V, platelets, proteases, tissue factor, and impairing finbrinolysis
	**“Second hit” stressors: smoking, prolonged immobilization, pregnancy, exogenous estrogen, malignancy, nephrotic syndrome, ~~HTN~~, hyperlipidemia		**“Second hit” stressors: smoking, prolonged immobilization, pregnancy, exogenous estrogen, malignancy, nephrotic syndrome, hypertension, hyperlipidemia

	==Clinical Features==		==Clinical Features==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-23T22:04:56Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Revisión anterior		Revisión del 22:04 23 jul 2016
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	{{Hemolytic anemia DDX}}		{{Hemolytic anemia DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Presence of DVT, arterial thrombus, or pregnancy morbidity (eg fetal loss, preterm)		*Presence of DVT, arterial thrombus, or pregnancy morbidity (eg fetal loss, preterm)
	*Presence of aPL		*Presence of aPL

ClaireLewis: /* Clinical Features */

2016-07-14T09:21:26Z

Clinical Features

← Revisión anterior		Revisión del 09:21 14 jul 2016
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	*Heart valve disease		*Heart valve disease
	*aPL-nephropathy		*aPL-nephropathy
	*Stroke/TIA, other neuro sx		*Stroke/TIA, other neuro symptoms
	*Livedo reticularis		*Livedo reticularis

Neil.m.young: Text replacement - " w/ " to " with "

2016-07-12T03:09:22Z

Text replacement - " w/ " to " with "

← Revisión anterior		Revisión del 03:09 12 jul 2016
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	==Complications==		==Complications==
	*Catastrophic APS: widespread thrombotic disease w/ multiorgan failure precipitated by some stress (eg infection)		*Catastrophic APS: widespread thrombotic disease with multiorgan failure precipitated by some stress (eg infection)

	==See Also==		==See Also==